Kellie Elisabetta Hicks, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024180560 Issued in VA

Practice address

63 Scotts Ford LN
Fredericksbrg, VA 22406-5478

Phone

(540) 898-7823

NPI assigned

Nov 28, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: khicks74564@marywashingtonhealthcare.direct-ci.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606521600000",
    "number": "1154925360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 SCOTTS FORD LN",
            "city": "FREDERICKSBRG",
            "state": "VA",
            "postal_code": "224065478",
            "telephone_number": "540-898-7823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 SCOTTS FORD LN",
            "city": "FREDERICKSBRG",
            "state": "VA",
            "postal_code": "224065478",
            "telephone_number": "540-898-7823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "KELLIE",
        "middle_name": "ELISABETTA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-28",
        "last_updated": "2020-11-28",
        "certification_date": "2020-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024180560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "panda81879@aol.com",
            "affiliation": "N",
            "endpointDescription": "home address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "fredericksburg",
            "address_1": "63 Scotts Ford Ln",
            "city": "Fredericksbrg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "224065478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Janet Leon Villasenor
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• Patricia Jean Mikula, PTA

• All providers in Fredericksbrg, VA
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.